Disability and depression after orthopaedic trauma

IntroductionMusculoskeletal injury is a common cause of impairment (pathophysiology), but the correlation of impairment with pain intensity and magnitude of disability is limited. Psychosocial factors explain a large proportion of the variance in disability for various orthopaedic pathologies.The aim of this study is to prospectively assess the relationship between psychological factors and magnitude of disability in a sample of orthopaedic trauma patients in The Netherlands.Material and methodsOne hundred and one adult patients between 1 and 2 months after one or more fractures, tendon or ligament injuries were enrolled. Four eligible patients refused to participate. Thirty-five women and 30 men with an average age of 50 years (range, 22-92 years) completed the follow-up evaluation between 5 and 8 months after their injury and their data was analyzed. The patients completed a measure of disability (the Short Musculoskeletal Function Assessment-Netherlands, SMFA-NL), the Dutch Centre for Epidemiologic Study of Depression-scale (CES-D), the Dutch Impact of Event Scale (SVL), and the Dutch Pain Catastrophizing Scale (PCS) at the time of enrollment and again 5-8 months after injury.ResultsThere were moderate correlations between symptoms of depression (CES-D, r = 0.48, p < 0.001) and symptoms of PTSD (SVL, r = 0.35, p = 0.004) at enrollment and magnitude of disability 5-8 months after trauma. Catastrophic thinking (PCS) at enrollment and magnitude of disability 5-8 months after trauma showed a small correlation (PCS, r = 0.26, p = 0.034). The Pain Catastrophizing Scale (Beta = 0.29; p = 0.049), surgery (Beta = 0.26; p = 0.034), additional surgery (Beta = 0.26; p = 0.019) and other pain conditions (Beta = 0.31; p = 0.009) were the significant predictors in the final model (adjusted R-squared = 0.35; p < 0.001) for greater disability 5-8 months after trauma.Discussion and conclusionsIn The Netherlands, symptoms of depression measured 1-2 months after musculoskeletal trauma correlate with disability 5-8 months after this trauma. The psychological aspects of recovery from musculoskeletal injury merit greater attention.Level of evidenceLevel II, Prognostic study.